The present invention relates to a surgical clip designed to be inserted into a small size access port on cannula, an associated clip applicator and a method therefor
The current trend in minimally invasive surgery is to utilize smaller and smaller ports for access to the surgical site via cannulae or small tubes for insertion into body cavities. Currently, 5 mm ports are being utilized instead of the original 10 mm port for instrument access in laparoscopy and other types of minimally invasive surgery. In addition, 2 to 3 mm ports are being used for access and, as a result, smaller instruments are required to operate through these smaller ports and cannulae.
A frequently used instrument in minimal access surgery is a clip applier or clip applicator. This instrument is utilized in most operations for the ligation of vessels, tubular structures and other organs or organic bodies. One of the problem encountered by the reduction in size of the clip applier is that there is an irreducible dimension between the legs of the clip which is required to enable the clip to encircle the target structure (i.e.; blood vessel or other organic body). Since most clips are applied to the blood vessel or body in an open, incipient, clip-on position (excluding springs clips), the dimension exceeds 5 mm, precluding access through a 5 mm or smaller access port on cannulae. Clips small enough to be introduced through a small port (5 mm or less) lose their utility because the small opening between the jaws or the legs of the clip minimize the usefulness or utility of the clip.
The following patent disclosures show surgical clips: U.S. Pat. No. 3,326,216 to Wood; U.S. Pat. No. 4,188,953 to Klieman et al.; U.S. Pat. No. 4,449,530 to Bendel et al.; U.S. Pat. No. 4,844,066 to Stein; U.S. Pat. No. 4,971,198 to Mericle; U.S. Pat. No. 4,972,949 to Peiffer; U.S. Pat. No. 5,192,288 to Thompson et al.; U.S. Pat. No. 5,330,442 to Green et al.
The following patent disclosures show surgical instrument handles: U.S. Pat. No. 5,582,615 to Foshee et al. and U.S. Pat. No. 5,709,706 to Kienzle et al.
It is an object of the present invention to correct or circumvent the major problem of utilizing smaller and smaller access ports on cannulae by providing a specially designed surgical clip and an associated clip applicator.
It is another object of the present invention to provide a surgical clip which can be partially closed to reduce the clip leg span thereby permitting insertion into small access ports.
It is another object of the present invention wherein surgical clips, classified as medium, medium large, or large sizes (all currently requiring the use of larger than 5 mm access ports), can be inserted into 5 mm access ports (or smaller) when the clips are constructed in accordance with the principles of the present invention.
It is a further object of the present invention to provide surgical clips having terminal ends with a lateral span being larger than the span of the clip leg body such that the flare ends coact with channels on the clip jaws of the clip applier thereby permitting the clip applier to partially close the captured clip prior to insertion through a small access port, then permitting expansion of the surgical clip after the clip and the clip jaws pass through the distal port on the cannula such that the clip can be opened to a full clip leg span and then applied, by compression, onto the blood vessel or other organic body.
It is a further object of the present invention to provide clip applier or clip applicator designs utilizing the specially designed surgical clips.
It is an additional object of the present invention to provide one tactile response to the operator indicative of a partially closed, insertion position or a fully closed position or a post deposition clip release position.
The surgical clip includes a U or a V shaped body having clip legs extending from its apex. The clip legs lie in an imaginary clip defined plane and the terminal ends of each clip leg have a lateral span extending outboard from the clip defined plane. The terminal ends, in certain embodiments, take the shape of a triangle, an oval, a T-shape, an oblong and a wide end hexagonal shape. In another embodiment, the clip""s terminal ends include outboard directed hooks. The inboard surface of the surgical clip may have gripping grooves thereon. A clip applicator is utilized to carry the surgical clip to the surgical site. The clip applicator includes a first and a second clip carrying jaw pivotally coupled together to form a clip jaw mouth therebetween. At the distal end of each clip jaw, an open ended channel is formed as a keyway. The keyway is sized to capture a respective terminal clip end therein such that the terminal clip end acts as a key for the keyway when the clip is retained in the clip jaw mouth. If the clip defines hooked terminal ends, the clip jaws define complementary latch openings. The clip applier also includes a system for closing the clip jaws onto each other. The system for closing includes a variety of structures including linked scissor-like members, cam actuators and cam follower channels or cam follower surfaces responding to longitudinal movement of the cam actuators. In a preferred embodiment, the surgical instrument or clip applier includes tactile response indicators (which may be detents on the clip jaws or proximal jaw bodies) providing an indicator to the user that the clip jaws are in a partially closed, instrument insertion position or a fully closed clip compression position or a post deposition clip release position.